Health Effects of Cannabis and Cannabinoids - PowerPoint Presentation

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Health Effects of Cannabis and CannabinoidsCurrent State of Evidence and Recommendations for Research

This report

is available to download

as a free

pdf:

N

ationalacademies.org/

CannabisHealthEffects

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Outline of PresentationBrief overview of study context and statement of taskOverview of study approach

Therapeutic effects of Cannabis and Cannabinoids

Overview of key health effects of Cannabis

Identified research barriers and recommendations

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Brief Overview of Study Context and Statement of Task

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Marijuana

 and Health 

(

1982)

Marijuana and Medicine:

Assessing

the Science Base 

(1999)

Study Context

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Develop

a comprehensive, in-depth review of existing evidence regarding the

health effects (both harms and benefits) of cannabis and cannabinoids use

Make short- and long-term recommendations

regarding a research

agenda to identify

the most critical research

questions and advance the cannabis and cannabinoid research agenda

Summary of Statement of Task

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Study SponsorsAlaska Mental Health Trust Authority

Arizona Department of Health

Services

California Department of Public Health

CDC Foundation

Centers for Disease Control and Prevention (CDC)

Food and Drug AdministrationMat-Su Health FoundationNational Cancer Institute - National Institutes of Health

National Highway Traffic Safety AdministrationNational Institute on Drug Abuse-National Institutes of HealthOregon Health AuthorityRobert W. Woodruff FoundationThe Colorado Health FoundationTruth InitiativeWashington State Department of Health

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Committee

on the Health Effects of Marijuana: An Evidence Review

and

Research

Agenda

MARIE

C. MCCORMICK

(chair), Harvard T.H. Chan School of Public Health, MADONALD I. ABRAMS, Zuckerberg San Francisco General Hospital

MARGARITA ALEGRÍA, Massachusetts General Hospital

WILLIAM

CHECKLEY, Johns Hopkins University, MDR. LORRAINE COLLINS, University at Buffalo-SUNY, Buffalo, NY

ZIVA

D. COOPER,

Columbia University Medical Center,

NY

ADRE J. DU

PLESSIS,

Children National Health

System, D.C.SARAH FELDSTEIN EWING, Oregon Health and Science UniversitySEAN HENNESSY, University of PennsylvaniaKENT HUTCHISON, University of Colorado Boulder

NORBERT E. KAMINSKI,

Michigan State University

SACHIN PATEL,

Vanderbilt University Medical Center, TN

DANIELE PIOMELLI,

University of California, Irvine

STEPHEN SIDNEY

,

Kaiser Permanente Northern California

ROBERT B. WALLACE,

University Of Iowa College of Public Health

JOHN WILLIAMS

, Duke University Medical Center, NC

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Overview of Study Approach

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Study ApproachCommittee member expertise included:

substance

abuse

cardiovascular health

general epidemiology

immunology

pharmacologypulmonary healthBetween June and December 2016, the committee held

5 in-person meetings and 1 virtual meetingThe committee held 2 open session meetingsneurodevelopmentoncologypediatricspublic healthsystematic review methodologya

nd others…

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Study Approach (further detailed in the full report)

Adopted key features of a systematic review process

Conducted

an extensive search of relevant

databases (e.g., Medline

, Embase, the Cochrane Database of Systematic Reviews,

PsycINFO)Initial search resulted in more than 24, 000 articles Committee considered more than 10,000 abstracts to determine relevance for the reportPrimacy given to recently published systematic reviews and high-quality primary research that studied one or more

of the committee’s 11 prioritized health endpoints

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Study Approach– 11 prioritized health endpoints

Therapeutic effects

Cancer incidence

Cardiometabolic

risk

Respiratory diseaseImmune function

Injury and deathPrenatal, perinatal, and postnatal outcomesPsychosocial outcomesMental healthProblem cannabis use

Cannabis use and abuse of other substance

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Study approach (further detailed in the full report)

Standardized language

to categorize the weight of evidence

5 levels of evidence

CONCLUSIVE

SUBSTANTIAL

MODERATELIMITEDNO or INSUFFICIENT

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Study Process– Special Considerations

Biological

Plausibility

Considerations of Observational Studies

Comparing

Harms and Benefits of Cannabis

Use

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Review of Select Chapter Highlights

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TherapeuticsIn adults with chemotherapy induced nausea and vomiting, oral cannabinoids are effective

antiemetics

.

In

adults with chronic pain, patients who were treated with cannabis or cannabinoids are more likely to experience a clinically significant reduction in pain symptoms

In

adults with multiple sclerosis (MS) related spasticity, short-term use of oral cannabinoids improves patient-reported spasticity symptoms. For these conditions the effects of cannabinoids are modest; for all other conditions evaluated there is inadequate information to assess their effects.

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Health Effects of Cannabis

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Respiratory DiseaseThere is substantial evidence of a statistical association between long-term cannabis smoking and worse respiratory symptoms and more frequent chronic bronchitis episodes.

There

is moderate evidence of a statistical association between

cessation

of cannabis smoking and improvements in respiratory symptoms

.

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Respiratory DiseaseThere is limited evidence of a statistical association between occasional

cannabis smoking

and an increased risk of developing chronic obstructive pulmonary

disease (COPD) when controlled for tobacco use.

There is insufficient evidence to support or refute a statistical association between cannabis smoking and hospital admissions for COPD

.There is insufficient evidence to support or refute a statistical association between cannabis smoking and asthma development or asthma exacerbation.

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Cancer There is moderate evidence of no

statistical association between cannabis smoking and the incidence of lung

cancer.

There is moderate evidence of

no

statistical association between cannabis use and the incidence of head and neck cancers.

There is limited evidence of a statistical association between current, frequent, or chronic cannabis smoking and non-seminoma-type testicular germ cell tumors.

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Cancer There is insufficient evidence to support or refute a statistical association between cannabis smoking and the incidence of esophageal cancer.

There is insufficient evidence to support or refute a statistical association between cannabis use and the incidence of prostate cancer, cervical cancer, malignant gliomas, non-Hodgkin lymphoma, penile cancer, anal cancer, Kaposi’s sarcoma, or bladder cancer.

There is insufficient evidence to support or refute a statistical association between parental cannabis use and a subsequent risk of developing acute myeloid leukemia/acute non-lymphoblastic leukemia, acute lymphoblastic leukemia, rhabdomyosarcoma, astrocytoma, or neuroblastoma in offspring.

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Injury and DeathCannabis use prior to driving increases the risk of being involved in a motor vehicle accident. In

states where cannabis use is legal, there is increased risk of unintentional cannabis overdose injuries among children.

It

is unclear whether and how cannabis use is associated with all-cause mortality or with occupational injury.

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ImmunityThere exists a paucity of data on the effects of cannabis or cannabinoid-based therapeutics on the human immune system.

There

is insufficient data to draw overarching conclusions concerning the effects of cannabis smoke or cannabinoids on immune competence.

There

is limited evidence to suggest that regular exposure to cannabis smoke may have anti-inflammatory activity.

There

is insufficient evidence to support or refute a statistical association between cannabis or cannabinoid use and adverse effects on immune status in individuals with HIV.

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Prenatal, Perinatal, and Neonatal OutcomesSmoking

cannabis during pregnancy is linked to lower birth weight in the

infant

The

relationship between smoking cannabis during pregnancy and other pregnancy and childhood outcomes is unclear.

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PsychosocialRecent cannabis use impairs the performance in cognitive domains of learning, memory, and attention. Recent use may be defined as cannabis use within 24 hours of evaluation.

A

limited number of studies suggest that there are impairments in cognitive domains of learning, memory, and attention in individuals who have stopped smoking cannabis.

Cannabis

use during adolescence is related to impairments in subsequent academic achievement and education, employment and income, and social relationships and social roles.

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Mental HealthThere is substantial evidence of a statistical association between cannabis use and the development of schizophrenia or other psychoses, with the highest risk among the most frequent users.

Marconi et al., 2016 Schizophrenia Bulletin

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Mental HealthIn

individuals with schizophrenia and other psychoses, a history of cannabis use may be linked to better performance on learning and memory tasks.

Cannabis

use does not appear to increase the likelihood of developing depression, anxiety, and posttraumatic stress disorder.

For

individuals diagnosed with bipolar disorders, near daily cannabis use may be linked to greater symptoms of bipolar disorder than non-users.

Heavy cannabis users are more likely to report thoughts of suicide than non-users.Regular cannabis use is likely to increase the risk for developing social anxiety disorder.

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Problem Cannabis UseGreater frequency of cannabis use increases the likelihood of developing problem cannabis use.Initiating

cannabis use at a younger age increases the likelihood of developing problem cannabis use.

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Cannabis Use and Abuse of Other SubstancesThere is limited evidence of a statistical association between cannabis use and the initiation of tobacco use

.

There is limited evidence of a statistical association between cannabis use and changes in the rates and use patterns of other licit and illicit substances.

There is moderate evidence of a statistical association between cannabis use and the development of substance dependence and/or a substance abuse disorder for substances including, alcohol, tobacco, and other illicit drugs.

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Barriers to Cannabis Research

There are specific regulatory barriers, including the classification

of cannabis as a Schedule I substance, that impede the advancement of cannabis and cannabinoid research

It

is often difficult for researchers to gain access to the quantity, quality, and type of cannabis product necessary to address specific research questions on the health effects of cannabis use

A

diverse network of funders is needed to support cannabis and cannabinoid research that explores the beneficial and harmful health effects of cannabis use To develop conclusive evidence for the effects of cannabis use on short- and long-term health outcomes, improvements and standardization in research methodology (including those used in controlled trials and observational studies) are needed

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Report Recommendations

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Recommendation 1: Address Research Gaps

To

develop a comprehensive evidence base on the short- and long-term health effects of cannabis use (both beneficial and harmful effects),

public agencies, philanthropic and professional organizations, private companies

, and

clinical and public health research groups

should provide funding and support for a national cannabis research agenda that addresses key gaps in the evidence base. Prioritized research streams and objectives should include, but need not be limited to:Clinical and Observational ResearchHealth Policy and Health Economics ResearchPublic Health and Public Safety Research

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Recommendation 2: Improve Research Quality

To

promote the development of conclusive evidence on the short- and long-term health effects of cannabis use (both beneficial and harmful effects), agencies of the

United States Department of Health and Human Services

, including the

National Institutes of Health

and the Centers for Disease Control and Prevention should jointly fund a workshop to develop a set of research standards and benchmarks to guide and ensure the production of high-quality cannabis research.

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Recommendation 3: Improve Surveillance Capacity

To ensure that sufficient data are available to inform research on the short- and long-term health effects of cannabis use (both beneficial and harmful effects), the

Centers for Disease Control and Prevention, the Substance Abuse and Mental Health Services Administration, the Association of State and Territorial Health Officials, National Association of County and City Health Officials, the Association of Public Health Laboratories, and state and local public health departments

should fund and support improvements to federal public health surveillance systems and state-based public health surveillance efforts.

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Recommendation 4: Address Research Barriers

The

Centers for Disease Control and Prevention, National Institutes of Health, Food and Drug Administration, industry groups, and nongovernmental organizations

should fund the convening of a committee of experts tasked to produce an objective and evidence-based report that fully characterizes the impacts of regulatory barriers to cannabis research and that proposes strategies for supporting development of the resources and infrastructure necessary to conduct a comprehensive cannabis research agenda.

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Thank you for your support of this important study.Questions?

This report is now available and can downloaded as a free pdf

at:

nationalacademies.org/

CannabisHealthEffects

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